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When purchasing medical or critical illness insurance, many people focus mainly on product price and coverage amount, overlooking another key aspect: claims. Reviewing an insurer’s claims report can offer insights into its claim’s efficiency, payout patterns, and even current health trends. My company recently released its 2023 Individual Life Insurance Claims Report¹, analyzing data and cases submitted by Hong Kong customers last year. The report examined the three major types of claims—critical illness, hospitalization, and death—exploring health issues that closely affect everyday life and helping the public better understand relevant information. Below are some noteworthy findings.
Top Three Causes of Hospitalization Claims
Stomach and abdominal pain are common urban ailments that many dismiss as minor discomforts. However, according to the report, digestive system diseases were the leading cause of hospitalization claims, accounting for 28,535 cases—or one-quarter of all hospital claims last year—roughly 80% higher than the second most common cause, tumors (15,792 cases). Ranking third were respiratory diseases, with 15,009 hospital claims recorded for the year.
These figures show that symptoms such as “indigestion,” “bloating,” or “just a little cough” should not be taken lightly. Apart from seeking timely medical attention, individuals should also take preventive steps by choosing appropriate medical and health protection based on their needs and budget.
Improving Claims Efficiency
Another focus of the report is operational efficiency, such as claim approval rates and average processing times. Insurers understand that claim turnaround time is a key factor for policyholders when purchasing insurance, so the industry has invested more resources to boost efficiency.
For instance, through digital technology, my company reduced its average hospital claim processing time from four working days in 2022 to 2.8 days in 2023. Meanwhile, average processing time for critical illness and death claims improved by nearly 33% to 4.6 working days. The goal is to ensure customers receive timely payouts during critical moments—giving them peace of mind and allowing them to focus on recovery during difficult times.
(This article was published in the May 2024 issue of ET Net.)
1 Prudential 2023 Individual Life Claims Report
https://www.prudential.com.hk/tc/.galleries/pdf/promotion/individual-life-claim-report-2023.pdf
Note: This article has been converted from Traditional Chinese to English for website language display purposes. For the original content and reference materials, please refer to the Traditional Chinese version of the page.
